Proposer's Name	A value is required.
Contact Name
Address		Postcode
Telephone	A value is required.	Email	A value is required.Invalid format.

Business Description

No of Years In Business

Number of Employees

Renewal Date

Number of properties	One Two Three Four
Address of Property if different

-Walls - Brick Brick/Steel Steel Wood Concrete Other - Roof - Slate Steel Concrete Timber/Felt Other - Floors - Concrete Stone Wood Other - Heating - Gas CH Electric Oil Portable Heaters None - Electrics Checked - Less than 12 months Less than 3 years Less than 5 Years Other - Intruder Alarm - BT Redcare Digital Commmunicator Bells Only None - Alarm Maintained - Yes No
- Other Occupants - Yes No	if yes

Buildings	£
Loss of rent	£
Stock (ex non ferrous metals)	£
Stock of non-ferrous metals	£
Contents (ex Computers)	£
Computer Equipment	£
Tenants Improvements	£
Deterioration of Frozen Stock	£
Residual Computer Breakdown (additional costs)	£ Nil £20,000 £30,000 £40,000 £50,000 £100,000
Business Interruption (Loss of Profits)	£
Business Interruption Indemnity Period	Months
Book Debts	£
Turnover	£
Clerical and Sales Wages	£
All Other Employee Wages	£
Manual Work Away Wages (ex bona-fide sub-contractors	£
Payments to bon-fide sub-contractors	£
Heat Work Away	£
% of manual work relating to heat work away	%
Goods in Transit	£

All Risks	Description of Item	Europe or Worldwide	Sums Insured
		Europe Worldwide
		Europe Worldwide
		Europe Worldwide
		Europe Worldwide
		Europe Worldwide

Legal Expenses	No Yes
including Contract Cover	No Yes

Claims	Date	Cause	Amount

Please use this space to tell us about any other factors that you may feel are important or may affect the opinion of underwriters in assessing the risks associated with the insurance proposed.